Hypoglycemia anticipation, awareness and treatment training (HAATT) reduces occurrence of severe hypoglycemia among adults with type 1 diabetes mellitus

Abstract

Severe hypoglycemia (SH) can be a significant problem for patients around the world with Type 1 Diabetes Mellitus (T1DM). To avoid SH, patients need to better manage, and reduce the occurrence of, preceding mild hypoglycemia. Hypoglycemia Anticipation, Awareness and Treatment Training (HAATT), developed in the United States specifically to address such issues, was evaluated at short- and long-term follow-up in a medically, economically and culturally different setting; Bulgaria. Sixty adults with T1DM and a history of recurrent SH (20 each from Sofia, Russe, and Varna, Bulgaria) were randomized to Self-Monitoring of Blood Glucose (SMBG) or SMBG+ HAATT. For 6 months before and 1 to 6 and 13 to 18 months after intervention, participants recorded occurrence of moderate, severe, and nocturnal hypoglycemia. For 1-month pre- and post-intervention, participants completed daily diaries concerning their diabetes management. Relative to SMBG, HAATT produced significant improvement in occurrence of low BG, moderate, severe, and nocturnal hypoglycemia, and detection and treatment of low BG (p values < .05 to < .001), with no compromise in metabolic control. At long-term follow-up, HAATT participants continued to have significantly fewer episodes of moderate and severe hypoglycemia. These findings suggest that a structured, specialized psycho-educational treatment program (HAATT) can be highly effective in managing hypoglycemia.

Interventions That Restore Awareness of Hypoglycemia in Adults With Type 1 Diabetes: A Systematic Review and Meta-analysis

“…Neither study assessed counterregulatory hormone responses. (43,44) and Hypoglycemia Anticipation, Awareness and Treatment Training (HAATT) (46)]. The longest follow-up was 4.9 years in the BGAT programs (48).…”

“…Three studies specifically recruited participants with IAH: HyPOS (43,44) and HAATT (46). Similar to PRIMAS, HyPOS compared a biopsychosocial education program with a standard education program, specifically in patients with previous SH.…”

Flexible Intensive Insulin Therapy in Adults With Type 1 Diabetes and High Risk for Severe Hypoglycemia and Diabetic Ketoacidosis

“…Blood glucose awareness training is an alternative standard self-management program approach that proved to decrease the rate of severe hypoglycemia in type 1 diabetes (15,16). In a 12-month uncontrolled trial, blood glucose awareness training reduced the rate of severe hypoglycemia from 19.2 to 13.2 events ⅐ patient Ϫ1 ⅐ year Ϫ1 (17).…”

Improving management of type 1 diabetes in the UK: the Dose Adjustment For Normal Eating (DAFNE) programme as a research test-bed. A mixed-method analysis of the barriers to and facilitators of successful diabetes self-management, a health economic analysis, a cluster randomised controlled trial of different models of delivery of an educational intervention and the potential of insulin pumps and additional educator input to improve outcomes

“…The curriculum included review of the mechanisms of hypoglycaemia and hypoglycaemia unawareness and how best to avoid and treat it, recapitulating the original DAFNE curriculum. The literature was searched for evidence of existing programmes and three were found: Blood Glucose Awareness Training (BGAT), 123,124 Hypoglycaemia Anticipation, Awareness and Treatment Training (HAATT) 125 and HyPOS. 126 All aimed to foster improved symptom recognition and self-treatment practices and all were predicated on data showing that impaired hypoglycaemia awareness could be induced/reversed by hypoglycaemia exposure/avoidance [127][128][129][130][131][132] and increased the risk of severe hypoglycaemia sixfold.…”